Healthcare Provider Details

I. General information

NPI: 1568778256
Provider Name (Legal Business Name): JILL L BRYANT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 S HIGHWAY 25 W SUITE 52
WILLIAMSBURG KY
40769-1608
US

IV. Provider business mailing address

PO BOX 1535
BARBOURVILLE KY
40906-5535
US

V. Phone/Fax

Practice location:
  • Phone: 606-546-7777
  • Fax: 606-545-7611
Mailing address:
  • Phone: 606-546-7777
  • Fax: 606-545-7611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number49137
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: